Clinical impact of supraventricular tachycardias in patients with chronic thromboembolic pulmonary hypertension

Purpose: Supraventricular tachycardias (SVT) are frequently observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Their prevalence and impact on prognosis of patients are not known. Methods: We retrospectively studied the prevalence of SVT and survival in 315 patients with CTEPH (aged 62±14 years; 179 males; 218 proximal obstruction). Pulmonary endarterectomy (PEA) was performed in 155 patients. Mortality was assessed in subgroups composed according to type of treatment and SVT prevalence. Results: When arrhythmias attributable to surgical treatment were excluded, SVT was observed in 67 (21%) patients. Atrial fibrillation was the most prevalent (n = 42), followed by atrial flutter (n = 19), focal atrial tachycardia (n = 5), and AV nodal re-entrant tachycardia (n = 1). Total of 88 (28%) patients died during mean follow-up of 47±28 months. Mortality rates in patients with and without previously manifested SVT are shown in Table. In addition, new SVT was observed in 31 (20%) patients in the early period after PEA: atrial fibrillation (n=19), atrial flutter (n=11) and focal atrial tachycardia (n=1). Newly diagnosed SVT after PEA did not influence the clinical outcome. Mortality rates Conclusion: The prevalence of SVT in patients with CTEPH was high and predicted the mortality irrespective of surgical or medical treatment. Conversely, surgery-related atrial arrhythmias had no mortality impact.